Oral Health and Preventive Dentistry, 02/2006

Purpose: To survey an adult population in a deprived district of Karachi, with special reference to perceived oral health. Materials and Methods: One thousand questionnaires, covering topics such as socioeconomic status, general health and oral health were distributed to the participants' homes by dental auxiliaries, and 994 were returned. The respondents were adults aged between 30 and 50 years. Women comprised 49% of the sample. Results: Over half the participants (54%) perceived that they had oral problems: esthetic issues predominated (33%), but pain (17%), cavities (15%) and difficulty chewing (8%) were also reported. Most participants (94%) had dentitions of >= 20 teeth. There was a weak but significant negative correlation between age and number of teeth (r2=0.03, p0.001). Age and female gender were significantly associated with pain, bleeding gums and periodontitis. Pain was a more frequent complaint among poorly educated subjects than among the better educated. Diabetics comprised 17% of respondents and reported higher frequencies of dental problems, bleeding gums and calculus and fewer teeth. However, after compensation for age, gender, smoking, education and income, no significant associations were disclosed. Smoking was reported by 30% of all subjects and was significantly associated with pain, bleeding gums and periodontitis. Conclusion: The survey disclosed that over half the subjects in this sample of underprivileged Pakistani adults suffered from poor oral health, including pain. Keywords: treatment needs, oral health, Pakistan

Purpose: The purpose of this study was to evaluate a volatile sulfur compounds (VSCs) monitor's ability to assess oral malodour in patients with and without periodontal disease in comparison with the assessment by gas chromatography (GC) or organoleptic testing. Materials and Methods: Ninety-nine patients' mouth air was measured by GC, a VSCs monitor (BreathtronTM) and organoleptic test. Patients who had a periodontal pocket depth of 4 mm and more for at least two tooth surfaces were assigned to the periodontal disease group. Results: Total VSCs value by the BreathtronTM was higher in periodontal disease group than that in non-periodontal disease group, and it showed statistically significant correlations with specific VSCs gases from GC and with the organoleptic measurement. The BreathtronTM had high sensitivity in both groups. Conclusion: The BreathtronTM can be a reliable instrument for the diagnosis of halitosis. However, the BreathtronTM should be used properly for measuring VSCs that are related to periodontal disease. Keywords: Oral malodour assessment, volatile sulfur compounds (VSC)

Purpose: To compare the interdental plaque removal capacity of dental floss, a cylindrical and a conical interdental brushes. Material and Methods: Fifty individuals were selected from those attending a maintenance programme for periodontally treated patients. Upon written agreement, the Silness and Löe Plaque Index (Pl.I) was registered in nine interdental spaces in three quadrants. The patients were then instructed on the use of each device and performed the cleaning until they felt it was satisfactory using one instrument for each quadrant. The same calibrated examiner registered Pl.I again, unaware of the instruments used in each quadrant. Mean values were calculated and compared by One Way ANOVA + Bonferroni and paired sample t test (α=.05). Frequency distribution of scores 0+1 and 2+3 was also calculated and compared by Mc Nemar. Results: The mean Pl.I at start was 1.71 for dental floss, 1.69 for the conical and 1.66 for the cylindric interdental brushes. All three instruments reduced plaque significantly. Thus, the final mean Pl.I was 1.02, 0.46 and 0.42 for floss, conical and cylindric brushes, respectively. The final values observed for the interdental brushes were significantly smaller than those observed for floss. The same result was observed for the frequencies of 0+1 and 2+3 criteria of the Pl.I. Conclusion: It may be concluded that, for individuals in periodontal maintenance care, interdental toothbrushes, regardless of their shape (conical or cylindric) are more efficacious in interdental supragingival plaque removal than dental floss. Keywords: dental floss, efficacy, interdental brush, supragingival plaque control

Purpose: This study aimed to compare dental plaque removal efficacy of three manual toothbrushes. Materials and Methods: Three toothbrushes (Colgate Flexível® - Colgate (T1), Oral B Advantage® Control Grip® - Oral B® (T2), Comfort Clean®- Johnson & Johnson - Reach® (T3) were evaluated for dental plaque removal in 17 subjects. Dental plaque was scored before and after seven days' use of each toothbrush, employing an adaptation of Quigley-Hein Index modified by Turesky (Plaque Index). Assessments were performed at days 0, 7, 14, 21, 28, and 35. At the end of the trial each subject was asked which toothbrush was preferred. Results: Final dental plaque scores for toothbrush T3 were statistically different from toothbrushes T1 and T2, which in turn did not differ from each other. Subjects showed preference towards toothbrush T3. Conclusion: Toothbrush T3 was more efficient in terms of dental plaque removal when compared with toothbrushes T2 and T1. Keywords: toothbrushes, dental plaque, mechanical control

Purpose: Periodontitis is a common chronic disease globally. It is a major cause of tooth loss among adults, and recently has been suggested as a possible risk factor for some systemic diseases such as cardiovascular disease. In Saudi Arabia, research on periodontitis prevalence, as well as its relation to systemic diseases, is lacking. The objectives of this study were: (1) to determine the prevalence of periodontitis among a sample of Saudi Dental School patients population; and (2) to examine the association between periodontitis and systemic diseases in the selected sample. Materials and Methods: Retrospective evaluations of 282 randomly selected dental records were conducted. Age, gender, nationality and medical history were abstracted from these records. Number of remaining teeth and number of teeth with more than 20% of bone loss were determined from panoramic radiographs. Descriptive statistics, t-test, chi-square and regression models were used for data analyses. Results: About 68% of the sample had radiographic alveolar bone loss; of these, 28% had a localised and 40% had a generalised form. Prevalence of systemic diseases was generally higher among individuals with the generalised form. About 21% and 13% of those with generalised periodontitis reported history of diabetes and hypertension respectively, whereas only about 2% of those with localised periodontitis reported history of these diseases. Conclusion: The findings of the present study showed a high prevalence of periodontitis in the selected sample. There is an urgent need for further studies with larger sample size to confirm these findings and to implement an effective measure to reduce periodontitis prevalence in Saudi Arabia. Keywords: cardiovascular disease, diabetes, periodontitis, risk factors, Saudi Arabia

Purpose: To investigate the prevalence and distribution of marginal bone loss in the Danish population. Materials and Methods: Six hundred and sixteen randomly selected Danish adults (304 females and 312 males), mean age of 42 years (range 21-63 years) underwent a full-mouth radiographic survey consisting of 14 periapicals and two bitewings. The marginal bone level was measured with a digital caliper in mm, rounded off to the nearest 0.1 mm. The measurements were performed at the mesial and distal aspect of the tooth, from the cemento-enamel junction to the marginal bone. These measurements were used to calculate the marginal bone level (A) in mm for each tooth and each patient. Three thresholds were defined: normal marginal bone level (A 3 mm), borderline marginal bone level (3 mm = A 4 mm) and reduced marginal bone level (A >= 4 mm). Results: The prevalence of reduced marginal bone level in the individual and the frequency of teeth with reduced marginal bone level were almost similar. A reduced marginal bone level was evenly distributed among the tooth groups. Approximately 12% had reduced marginal bone level, 12% were in the borderline marginal bone level group, and the remaining 76% had a normal marginal bone level. The marginal bone level was ever more reduced with increasing age. No significant difference in bone level was observed between genders. Conclusions: The prevalence of reduced marginal bone level in a random Danish population is approximately 12% and is comparable to findings in other European countries. Keywords: cross-sectional study, epidemiology, marginal bone level, prevalence, radiology

This study investigated the association between several demographic, socio-economic, behavioural and clinical variables on caries activity. One hundred and two patients were randomly retrieved from the files of the Operative Dentistry Clinic (UFPel-Brazil). The patients gave written consent to participate in the study. They were interviewed reporting demographic (sex and age), socio-economic data (income, educaional level) and oral health behaviours (tooth-brushing frequency, dental floss usage and snacks frequency). Intraoral examination was performed to investigate the clinical variables (presence and quality of biofilm, DMFT and modified DMFT index and bleeding points). Patients were divided between caries-active (n=51) and caries-inactive (n=51), according to the presence of white spot lesions and/or active cavity lesions. Statistical analysis was carried tout using Chi-square or Fischer's exact test, with the confidence level at 95%. Results demonstrated that several conditions (younger subjects, lower educational or income levels, lower tooth-brushing frequency, higher snacks frequency, adherent biofilm, presence of bleeding points and higher modified DMFT index) were associated with caries activity in the studied population. Within the limitations of the experimental design, and considering the population under investigation, it was verified that demographic (age), socio-economic (income and educational levels), behavioural (tooth brushing and snacks frequencies) and clinical (modified DMFT index, presence and quality of biofilm, and bleeding points) variables were associated with caries-active patients. Keywords: caries activity, clinical trials, dental biofilm, oral health

Purpose: The purpose of this paper was to undertake a systematic review about the relationship between obesity in childhood, adolescence and/or adulthood and the prevalence of dental caries. Methods: The authors searched Bireme, Medline, ISI, Cochrane Library and the internet for papers from 1984-2004. The main search terms were 'obesity' and 'dental caries'. The inclusion criteria were studies that defined obesity (body mass index) and dental caries (total number of decayed, and filled teeth - DFT/DFS/dft/dfs) in their subjects. The following were excluded from this paper: articles on reviews, dietary guidelines, policy statements, papers related to oral health and nutrition deficiency - underweight, and with no relation between obesity and dental caries prevalence or dental health problems. Results: No systematic review has focused on correlating obesity and caries and only three studies had high levels of evidence. Conclusion: Only one study with high level of evidence showed direct association between obesity and dental caries. In view of the findings, further well-designed randomised studies are needed to demonstrate the relationship between dental caries and obesity. Keywords: review literature, dental caries, obesity, body mass index, DMF index

The aim of this study was to evaluate the reliability of a laser-induced infrared fluorescence method, DIAGNOdent, for measuring orthodontically induced white spot lesions. The subjects comprised 13 orthodontic patients, aged 13-17 years, who had recently completed fixed appliance therapy: 137 test teeth were selected, with white spot lesions on the facial or buccal smooth surfaces. An initial visual inspection was performed to localise and record the measuring region. The predetermined measuring regions were scanned to locate the sites of the highest reading. The readings and their corresponding sites were registered on the print out photographs. Following the measurement by the first examiner, the second and the third examiners took DIAGNOdent readings independently at the same lesion sites indicated on the photographs, under identical conditions. One week later, DIAGNOdent readings of the same lesions were retaken by the three observers working independently. Intra- and inter- examiner agreements on DIAGNOdent quantification of lesion severity were analysed by Intra-class correlation coefficient (ICC). The ICC values for intra-examiner agreement for the three examiners were 0.91, 0.97, and 0.98, respectively, with a mean value of 0.95, indicating excellent agreement. The ICC values for inter-examiner agreement were comparatively lower: 0.69 and 0.82 for the first and second measurements, respectively. It was concluded that the reliability of the DIAGNOdent readings on white spot lesions associated with orthodontic banding was good. Keywords: fluorescence, caries, smooth surface, reliability

Purpose: To evaluate and compare the long-term outcome of a population-based and a risk-based strategy of applying fissure sealants in newly erupted first permanent molars. Design and Setting: Retrospective cohort study in primary dental care. Materials and Methods: Four hundred and ninety-six subjects from two cohorts were included. In group P (n = 236), routine applications of fissure sealants were conducted while sealants were placed on the basis of subjective criteria in Group R (n = 260). Data of applications, maintenance, decay, restorations, extractions, and cumulative time of applications from six to 19 years were extracted from the dental records and bite-wing radiographs by two of the authors simultaneously. The main outcome measures were the total caries prevalence at the age of 19 years as well as the fate of each sealed and non-sealed occlusal surface. Results: In group P, 87.7% of all first permanent molars were sealed compared with 20.2% in group R. There was no statistically significant difference concerning the total DFT at 19 years of age between the groups (mean 3.5 ± 3.8 vs. 3.7 ± 3.4). Considering the occlusal surfaces of the first permanent molars only, a statistically significant treatment effect was demonstrated in group P with an odds ratio of 4.6 (95% CI: 3.0 - 6.7; p 0.05). The absolute risk reduction was 36.3% and the number needed to treat was 2.8. In Group R, no statistically significant treatment effect was disclosed (OR = 1.3; 95% CI: 0.9 - 1.7; risk reduction 5.5%). Conclusion: This 13-year follow-up showed that population-based applications of fissure sealants in first permanent molars shortly after eruption showed a statistically significant treatment effect on the occlusal surfaces at the age of 19 years, which was in contrast to findings from a cohort in which sealants were applied on the basis of an individual risk-based strategy. There were, however, no significant differences concerning the total caries experience between the two cohorts. Keywords: caries prevention, first permanent molars, fissure sealants, preventive strategies